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The atherosclerosis of the sinus node artery is associated with an increased history of supra-ventricular arrhythmias: a retrospective study on 541 standard coronary angiograms.

Ciulla MM, Astuti M, Carugo S - PeerJ (2015)

Bottom Line: Background.The ischemic damage of the sinus node (SN) is a well known cause of cardiac arrhythmias and can be a consequence of any flow abnormality in the sinus node artery (SNA).For the second objective, we studied the 333 patients with: (a) coronary artery disease (CAD), (b) properly evaluable SNA and (c) complete clinical history available.

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Affiliation: Laboratory of Clinical Informatics and Cardiovascular Imaging , Milan , Italy ; Department of Clinical Sciences and Community Health, University of Milan , Milan , Italy.

ABSTRACT
Background. The ischemic damage of the sinus node (SN) is a well known cause of cardiac arrhythmias and can be a consequence of any flow abnormality in the sinus node artery (SNA). Accordingly we aimed this retrospective study to: (1) evaluate the suitability of the standard coronary angiography to study the SNA and (2) determine if the percentage of subjects with a positive retrospective history of supra-ventricular arrhythmias (SVA) differs in patients with normal and diseased SNA ascertained at the time of coronary angiography. Methods and Results. Out of the 541 coronary angiograms reviewed the SNA was visible for its entire course in 486 cases (89.8%). It was found to arise from the right side of the coronary circulation in 266 cases (54.7%) slightly more often than from the left, 219 cases (45.1%). One patient had 2 distinct SNA arising from either side of the coronary circulation. For the second objective, we studied the 333 patients with: (a) coronary artery disease (CAD), (b) properly evaluable SNA and (c) complete clinical history available. In 51 (15.3%) a SNA disease was found, 41.2% of them had a positive SVA history, mainly atrial fibrillation (AF), whereas only 7.4% of patients with a positive history of SVA could be found in the non-SNA diseased. This difference was statistically significant (P < 0.001). Conclusions. (1) The evaluation of the SNA is feasible in clinical practice during a standard coronary angiography; (2) this may be relevant since angiographically detectable SNA disease was significantly associated with a positive history of SVA.

No MeSH data available.


Related in: MedlinePlus

Flow chart showing patient selection according to the exclusion criteria.∗, patients without medical record were excluded (n = 67); ∗∗, only the older angiography was considered for those patients who repeated the exam; ∗∗∗, this group comprehends the images obtained from the primary coronary catheterizations of patients affected by ACS where the SNA branched downstream the culprit lesion.
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fig-1: Flow chart showing patient selection according to the exclusion criteria.∗, patients without medical record were excluded (n = 67); ∗∗, only the older angiography was considered for those patients who repeated the exam; ∗∗∗, this group comprehends the images obtained from the primary coronary catheterizations of patients affected by ACS where the SNA branched downstream the culprit lesion.

Mentions: The remaining 333 were divided into four groups according to the presence/absence of SNA disease and previous clinical history of SVA. The flow chart that shows the selection of patients and the assignment to the study groups is reported in Fig. 1. The clinical profile of each group is shown in Table 2; representative coronary angiograms are shown in Fig. 2. All patient groups were homogeneous in median age and gender. The indication to the coronary catheterization was an ACS in 217 cases (65.2%), 94 (43.3%) of which were ST-segment elevation myocardial infarction. In the remaining cases, the coronary angiography was an elective procedure. No significant differences were found in the distribution of the indication to the coronary catheterization among the groups. Out of the total 333 cases, in 51 (15.3%) a SNA disease was found, in 26 cases the lesion consisted of a diffuse irregularity of the SNA wall, in 19 cases it was a focal stenosis of the SNA, and in the remaining 6 cases the lesion was located in the LCX or RCA upstream from the SNA origin (see Fig. 2). The prevalence of a previous clinical history of SVA was significantly higher in the SNA diseased group than in the non-SNA diseased (41.2% vs. 7.4 % P < 0.001) (Table 2). When taking into consideration the classification of SVA reported and their distribution according to the presence/absence of SNA disease, no significant differences where found (Table 3). The prevalence of known risk factors for CAD and SVA and of the cardiovascular therapies was homogeneous among all the groups with the following exceptions: the subjects with SNA disease had a significantly higher prevalence of prior acute myocardial infarction (AMI) (43.1% vs. 23.8%; P = 0.004), a significantly lower left ventricle ejection fraction (51.0% vs. 36.2% ; P = 0.045) and a significantly higher use of beta-blockers (47.1% vs. 31.2% ; P = 0.027) and thienopyridines (23.5% vs. 12.4%; P = 0.036) than non-SNA diseased. As expected, in subjects with a clinical history of SVA, irrespective of the presence of SNA disease, a higher prevalence of risk factors for arrhythmia, including a higher prevalence of reduced left ventricle ejection fraction and atrial dilatation, was found alongside with a significantly higher consumption of antiarrhythmic drugs (Table 2).


The atherosclerosis of the sinus node artery is associated with an increased history of supra-ventricular arrhythmias: a retrospective study on 541 standard coronary angiograms.

Ciulla MM, Astuti M, Carugo S - PeerJ (2015)

Flow chart showing patient selection according to the exclusion criteria.∗, patients without medical record were excluded (n = 67); ∗∗, only the older angiography was considered for those patients who repeated the exam; ∗∗∗, this group comprehends the images obtained from the primary coronary catheterizations of patients affected by ACS where the SNA branched downstream the culprit lesion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556151&req=5

fig-1: Flow chart showing patient selection according to the exclusion criteria.∗, patients without medical record were excluded (n = 67); ∗∗, only the older angiography was considered for those patients who repeated the exam; ∗∗∗, this group comprehends the images obtained from the primary coronary catheterizations of patients affected by ACS where the SNA branched downstream the culprit lesion.
Mentions: The remaining 333 were divided into four groups according to the presence/absence of SNA disease and previous clinical history of SVA. The flow chart that shows the selection of patients and the assignment to the study groups is reported in Fig. 1. The clinical profile of each group is shown in Table 2; representative coronary angiograms are shown in Fig. 2. All patient groups were homogeneous in median age and gender. The indication to the coronary catheterization was an ACS in 217 cases (65.2%), 94 (43.3%) of which were ST-segment elevation myocardial infarction. In the remaining cases, the coronary angiography was an elective procedure. No significant differences were found in the distribution of the indication to the coronary catheterization among the groups. Out of the total 333 cases, in 51 (15.3%) a SNA disease was found, in 26 cases the lesion consisted of a diffuse irregularity of the SNA wall, in 19 cases it was a focal stenosis of the SNA, and in the remaining 6 cases the lesion was located in the LCX or RCA upstream from the SNA origin (see Fig. 2). The prevalence of a previous clinical history of SVA was significantly higher in the SNA diseased group than in the non-SNA diseased (41.2% vs. 7.4 % P < 0.001) (Table 2). When taking into consideration the classification of SVA reported and their distribution according to the presence/absence of SNA disease, no significant differences where found (Table 3). The prevalence of known risk factors for CAD and SVA and of the cardiovascular therapies was homogeneous among all the groups with the following exceptions: the subjects with SNA disease had a significantly higher prevalence of prior acute myocardial infarction (AMI) (43.1% vs. 23.8%; P = 0.004), a significantly lower left ventricle ejection fraction (51.0% vs. 36.2% ; P = 0.045) and a significantly higher use of beta-blockers (47.1% vs. 31.2% ; P = 0.027) and thienopyridines (23.5% vs. 12.4%; P = 0.036) than non-SNA diseased. As expected, in subjects with a clinical history of SVA, irrespective of the presence of SNA disease, a higher prevalence of risk factors for arrhythmia, including a higher prevalence of reduced left ventricle ejection fraction and atrial dilatation, was found alongside with a significantly higher consumption of antiarrhythmic drugs (Table 2).

Bottom Line: Background.The ischemic damage of the sinus node (SN) is a well known cause of cardiac arrhythmias and can be a consequence of any flow abnormality in the sinus node artery (SNA).For the second objective, we studied the 333 patients with: (a) coronary artery disease (CAD), (b) properly evaluable SNA and (c) complete clinical history available.

View Article: PubMed Central - HTML - PubMed

Affiliation: Laboratory of Clinical Informatics and Cardiovascular Imaging , Milan , Italy ; Department of Clinical Sciences and Community Health, University of Milan , Milan , Italy.

ABSTRACT
Background. The ischemic damage of the sinus node (SN) is a well known cause of cardiac arrhythmias and can be a consequence of any flow abnormality in the sinus node artery (SNA). Accordingly we aimed this retrospective study to: (1) evaluate the suitability of the standard coronary angiography to study the SNA and (2) determine if the percentage of subjects with a positive retrospective history of supra-ventricular arrhythmias (SVA) differs in patients with normal and diseased SNA ascertained at the time of coronary angiography. Methods and Results. Out of the 541 coronary angiograms reviewed the SNA was visible for its entire course in 486 cases (89.8%). It was found to arise from the right side of the coronary circulation in 266 cases (54.7%) slightly more often than from the left, 219 cases (45.1%). One patient had 2 distinct SNA arising from either side of the coronary circulation. For the second objective, we studied the 333 patients with: (a) coronary artery disease (CAD), (b) properly evaluable SNA and (c) complete clinical history available. In 51 (15.3%) a SNA disease was found, 41.2% of them had a positive SVA history, mainly atrial fibrillation (AF), whereas only 7.4% of patients with a positive history of SVA could be found in the non-SNA diseased. This difference was statistically significant (P < 0.001). Conclusions. (1) The evaluation of the SNA is feasible in clinical practice during a standard coronary angiography; (2) this may be relevant since angiographically detectable SNA disease was significantly associated with a positive history of SVA.

No MeSH data available.


Related in: MedlinePlus